If I have unprotected sex with other HIV positive people will I get resistance?
I’m a HIV positive gay male aged 27, infected and diagnosed in 2007. I am currently healthy with a CD4 count of 560 and a viral load of 35,000 and not yet on any medication.
I’ve been scared to sleep with other positive men through fear of catching treatment resistant strains or worse. I am a passive partner and I’m afraid my question does relate to unprotected sex. I am aware of the risks associated therein, afterall it got me in this situation!
I would like to know if I were to sleep with a HIV positive guy, is it better for me if he is on meds and undetectable or would that put me more at risk of developing resistance?
Now I can ‘sero-sort’ I’d like to know what’s likely to be the safest way to prevent my situation getting any worse, be it developing drug resistance, superinfection or other hard to treat infections?
I am also immunised against hepatitis B. Am I truly safe against this if I were to unknowingly come into contact with it?
Thank you for your question.
The answer I am giving may seem a little long but is related to lots of people in a similar situation to yourself so I have tried to include all the relevant information.
Some people loose their libido after they find out they are HIV positive or are afraid to have unprotected sex and so do not want to have sex at all. This can affect their quality of life and make them feel depressed. Sex is an important part of life for most people, and HIV complicates this, but it should not stop you having a healthy sex life. It wasn’t clear whether you have stopped having sex altogether, or just that you are worried about other HIV-positive men.
The best answer to your question is less dependent on your partners status though, but on being able to have a discussion about the issues your raised – about resistance, treatment history and STIs.
Most HIV positive people will have had a resistance test and will know if they are resistant to any medication. Have you had a resistance test? If not then talk to your HIV doctor about getting one. Your potential risk to other HIV-positive partners is as important as their risk to you.
It is not known whether re-infection itself is an issue. If neither of you have resistance, the only risk is STIs. It is a problem though if resistance is involved. If either you or your partner have different resistance, then reinfection would pass the new resistance. The more resistance, the more serious the impact on future treatment choices. Drug resistance is an important reason to continue using condoms and with multidrug resistance this is essential.
Most HIV-positive people are very happy to talk about how they are doing or to support someone else who is new to this. This is where we can all support each other.
Viral load relates to the risk of reinfection, and when it is undetectable the risk of re-infection is likely to be very low, even if someone has a partially-resistant strain of HIV.
If you are having sex with someone who is HIV positive and not on treatment then providing that neither of you are resistant to medication there is likely to be little risk from re-infection. If they are resistant to some medication you would need to find out which medication they are resistant to, and decide if you would be happy to lose the choice of those drugs.
This really means that if having sex without condoms is important, you need to know a bit about your partners’ current treatment and history. This isn’t as difficult as it sounds. If you are both positive, then you both will feel better if you can make an informed choice about your risks. It is very common for people to feel that getting HIV is enough. Saying you don’t want more health problems upfront is fine, and shows respect for yourself. Sero-sorting when both partners are HIV-positive can be a very important aspect of life, while coming to terms with other ways that HIV has affected your.
Any unprotected sex obviously carries a risk of infection with other sexually transmitted infections (STI). Co-infection with hepatitis C is a real risk amongst HIV positive gay men, and there is no vaccine. Your HIV clinic should test for hepatitis C and other STIs annually, or as necessary.
Your hepatitis B vaccine will protect you from HepB. You should also have a vaccine for hepatitis A. The level of immunity you have for hepatitis A and hepatitis B should also be checked by you HIV clinic annualy. Some people do not need booster vaccinations for 5-10 years after the initial dose.
For any further information or if you need any support then please do not hesitate to contact us on the treatment information helpline (Mon-Wed 12-4pm)